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Noor Mohsin, Psychology HL 2011-10-29

Discuss validity and reliability of diagnosis (Q.4)


Diagnosis, validity and reliability are words of important definitions. Diagnosis means identifying a disease on the basis of symptoms and other signs. Validity is defined as to which extent the diagnosis is accurate and reliability is defined as to what extent several psychiatrists agree on a patients diagnose when using the same diagnostic system. These two terms work together very much when diagnosing a patient. In this essay I am going to discuss the validity and reliability of diagnosis. The diagnostic method is extremely good and very helpful, since it is the foundation for all treatment. When diagnosing a patient, a diagnose instrument is used. This is called DSM-IVTR from 1952 and includes 5 axes in which the diagnose finding is carried out. Axis 1: Main Diagnose Axis 2: Development, personality disorder, perception and response to the world. Axis 3: medical status Physical problems are relevant for the mental disorder.

Axis 4: Social situation, unemployment, family situation etc. Axis 5: overall assessment of individuals functions. Diagnostic systems provide a set of templates which the clinician can use to compare information about disorders to the condition of particular client. This gives the clinicians the opportunity to use the same models for diagnosis. These systems are very effective and can be measured using the two variables validity and reliability. The validity of a classification system is dependent on its ability to classify a real pattern of symptoms, which might perhaps lead to an effective treatment. The classification system is very descriptive and it does not identify specific causes for disorders, therefore it is very difficult for people to fit into it. It is also difficult to make a valid diagnosis for psychiatric disorders, since there are no objective physical signs of such disorders. This means that the validity of this diagnose system is very weak, because not all people fit perfectly into this diagnose instrument. In order for a classification system to be reliable, different clinicians that use the same classification system should agree on the same diagnosis for the same individual. The diagnose system mentioned above has both strengths and weaknesses.

Noor Mohsin, Psychology HL 2011-10-29

Since axis 1 needs to be extremely specific and not all people can fit into it, its validity is very weak, however it has a strong reliability because then two or more clinicians have given the same exact diagnose. Also, if axis 1 and 2 overlap for the same disorders, the results are the same as for axis 1. So therefore, the validity is weak since it is hard to determine which diagnose the person is supposed to receive. Also, cultural differences give different symptoms and this has also low validity when diagnosing. A study conducted by Rosenhan (1973) investigates the reliability of diagnosis using DSMII. He used 8 people, which were also researchers, which tried to gain admission to 12 different psychiatric hospitals. They all said that they were hearing voices and seven of them were diagnosed with schizophrenia. When they were admitted, they immediately said that they felt fine and that the voices had disappeared, so they were discharged 19 days later diagnosed with schizophrenia in remission. Rosenhan concluded that it is not possible distinguish between real and fraud diseases, due to lack of scientific evidence. So are treatments properly justified? Another study conducted by Di Nardo (1993) deals with reliability of the diagnose method DSM-III for anxiety. This study is considered more reliable than Rosenhans study, when comparing the development of the diagnose methods used and also the year that the study was conducted. Di Nardo used 2 clinicians that were to separately diagnose 267 individuals that are seeking treatment for anxiety and stress disorders. The results were that high reliability was found for obsessive-compulsive disorders (0.80) and low reliability for assessing generalized anxiety disorders (0.50), due to problems with interpreting how excessive a persons worries is. In conclusion, one can state that this shows that diagnose instruments work for some diagnoses, but nor for all. It is very hard to fit people into specific categories, especially when considering the cultural aspect. This also shows that there is a high reliability when diagnosing OCD, but it is very low in general diagnosing.